questions

[Guest guest]

There are likely many scales that one could use to " stage " dementia.

Geri described the GDS (Global Deterioration Scale) in earlier posts, which

[i think] she was using to study the effects of various interventions on

disease course and/or level of illness.

In the Predictors study, we're using something called the CDR (Clinician's

Dementia Rating) scale, where an " OVERALL CDR RATING " of:

0 = healthy

0.5 = questionable dementia (Most MCI patient's fall in this category)

1 = mild dementia

2 = moderate dementia

3 = severe dementia

The " overall cdr rating " is determined by rating the person-of-interest on

six different domains of functioning (called box-scores): Memory,

Orientation, Judgement and Problem Solving, Community Affairs, Home and

Hobbies, and Personal Care... on a scale from 0 to 3. However, the

" overall cdr rating " is not simply an average of the box-scores, because

some domains (i.e., memory and orientation) are weighted more heavily than

other domains (i.e., community affairs). So, you need to use the algorithm

[which you can find at the link below] to calculate the " overall CDR rating "

by plugging-in a given patient's box-scores.

http://www.biostat.wustl.edu/~adrc/cdrpgm/index.html

Researchers have also developed two additional CDR ratings, as follows:

4 = profound dementia

5 = terminal dementia

Lot's have people have been talking about the end-stages of late. The

expansion of the CDR scale was necessary [w/ CDR of 4 (profound) and 5

(terminal)], because there were obvious differences between patients who

used to all be rated with just a CDR of 3 (severe). They did this to get

rid of the scale's " ceiling effect " - a phenomena/problem of scales which

demonstrate inability to discriminate between patients at the upper end of

the scales' range. The, so called, " floor effect " is the opposite problem -

the inability of a scale to discriminate between cases at the lower end of

the scales' range. Here are definitions for CDR's of 4 and 5:

CDR 4 = Profound dementia = " Speech usually unintelligible or irrelevant;

unable to follow simple instructions or comprehend commands. Occasionally

recognizes spouse or caregiver. Uses fingers more than utensils; requires

much assistance. Frequently incontinent despite assistance or training.

Able to walk a few steps with help; usually chair-bound; rarely out of

residence; purposeless movements often present. "

CDR 5 = Terminal dementia = " No responses or comprehension. No recognition.

Needs to be fed; may have NG tube and/or swallowing difficulties. Total

incontinence. Bedridden, unable to sit or stand, contractures. "

You can now see how expanding the CDR scale, somewhat eliminates the

" ceiling effect " of the CDR scale, as now patient's with CDR's of 3, 4, and

5, are all rather distinct from one another... Whereas, in the past, they

would all have just been lumped together with a CDR of 3!

Interestingly, even the Folstein Mini-mental State Exam (MMSE) suffers

somewhat from a " ceiling effect, " as it has difficulty discriminating

between those with Mild Cognitive Impairment (MCI) and those that are

healthy, at the upper end of the scale. Especially, if the patient is

well-educated. It's always important to look at individual cases carefully,

when interpreting scores on scales. Often, it's best to consider the

person's level of functioning and cognition BEFORE the onset of presenting

symptoms, in comparison to their current level of functioning and cognition.

For example, a NASA rocket scientist might still have a MMSE of 30 out of

30, and yet still be suffering from MCI, because (for them) they've had a

dramatic deterioration in their functioning and cognition... Yet, they're

still able to perform within the " normal/healthy " level of the MMSE.

It's like if Einstein had a head injury, and then you gave him an IQ test.

His IQ would drop down to, say, 100 [the mean of the whole population]...

and if you didn't know he was Einstein beforehand, you'd say that he was

just a " normal " guy that's suffer from no cognitive loss. Clearly, that

wouldn't be the case, because (for Einstein), you'd expect him to have an

exceptionally high IQ!

I digress, and I'm rambling... but, this is all very interesting stuff!

-Russ

(410)955-1647 / rjenkins@...

>

>I've read a lot in these digests about the various " stages " of LBD, but

only in the context that >you all agree there are various stages. Can

someone go over them again for me please .. or tell >me how to find them

somewhere?

>

[Guest guest]

Hmm... Maybe books-on-tapes?!

-Russ

(410)955-1647 / rjenkins@...

>

>Also, any ideas on how I can keep my mom's mind busy - since she's blind

she can't do puzzles or >read so she sleeps a lot.

>

[Guest guest]

Ah! Courage, beat me to the punch re: the books-on-tape idea! LOL!

-Russ

>Subject: Re: questions

>

>Hello Deb,

>

>How about books on tape? Can your mother read Braile? Does the nh your

>mother lives in allow pets? Perhaps she can visit with one of the other

>residents pets or the nh can arrange to have a cat/dog brought in for the

>residents? - this won't occupy all of her time but some of it. How about

>music..is she a fan? Is your mother's blindness a recent occurance or

>something that she has lived with for a while now? If the later, what did

>your mother do before...perhaps that can be incorporated at the nh?

>Wow, you've got me stumped on this one. What does a blind person do hobbie

>wise let alone having LBD to boot?

>Courage

>

[Guest guest]

Other issues with the Folstein MMSE are that it is generally ineffective

for dementias involving the frontal lobes. We are seeing this in our

research right now in rural areas...where the people with frontal lobe

symptoms are skewing the correlations between MMSE, Global deterioration

scale, and functional status. If we control for people that we " think "

have frontal lobe syndrome or fronto-temporal dementias, the scores of the

three instruments correlate quite nicely.

At 10:27 AM 8/13/2003 -0400, you wrote:

>Interestingly, even the Folstein Mini-mental State Exam (MMSE) suffers

>somewhat from a " ceiling effect, " as it has difficulty discriminating

>between those with Mild Cognitive Impairment (MCI) and those that are

>healthy, at the upper end of the scale. Especially, if the patient is

>well-educated. It's always important to look at individual cases carefully,

>when interpreting scores on scales. Often, it's best to consider the

>person's level of functioning and cognition BEFORE the onset of presenting

>symptoms, in comparison to their current level of functioning and cognition.

>For example, a NASA rocket scientist might still have a MMSE of 30 out of

>30, and yet still be suffering from MCI, because (for them) they've had a

>dramatic deterioration in their functioning and cognition... Yet, they're

>still able to perform within the " normal/healthy " level of the MMSE.

Geri

Geri R. Hall, Ph.D, ARNP, CS, FAAN

Associate Professor (Clinical)

University of Iowa College of Nursing

Iowa City, Iowa 52240

and

Advanced Practice Nurse

Behavioral Neurology

University of Iowa College of Medicine

Phone:

Fax:

E-mail: geri-hall@...

[Guest guest]

- Courage

Re: questions

>>

>>Hello Deb,

>>

>>How about books on tape? Can your mother read Braile? Does the nh your

>>mother lives in allow pets? Perhaps she can visit with one of the other

>>residents pets or the nh can arrange to have a cat/dog brought in for the

>>residents? - this won't occupy all of her time but some of it. How about

>>music..is she a fan? Is your mother's blindness a recent occurance or

>>something that she has lived with for a while now? If the later, what did

>>your mother do before...perhaps that can be incorporated at the nh?

>>Wow, you've got me stumped on this one. What does a blind person do

hobbie

>>wise let alone having LBD to boot?

>>Courage

>>

>

>

>

>

[Guest guest]

omigosh the attitute needs such adjustment after interferon and riba.....takes

alot of time too, I was on antidepressants to cop (lexaporo) . The ribavarin was

mostly headache. But yes, once its all over its ver irritable ,,,like why dont I

feel perfect again, it will pass with time. Ive just know gone off lexapro

after my last trial with zertex and they say Im clean. My mom dide in the middle

of it so i stayed on antidepressants. Ive just now goen off - 3 years and Im

not out to kill anyone - seriously a positive outlook lol, in fact I finally

cry at Hallmark movies again.

[Guest guest]

Well I am a working mom and if I don't über plan, everything goes to hell in a

hand basket.

I start by making a meal plan in advance that the whole family agrees on. And

then I get groceries ONCE a week. I will ONLY shop for veggies several times a

week. That keeps me from buying those chips that I desperately want! And then

the rest of it is pretty simple. I make several meals on Sunday and then more

meals on Wednesday. I use my slow cooler when I can. I make and freeze batches

of what my family calls " glee soup " . As in, I prep it, cook it and then freeze

it in ziploc bags during the commercial breaks of glee! Then there are no

excuses for not having a meal.

And something that really helps me is keeping non-perishable snacks on me at all

times. I pretty much always have some almonds/trail mix and an apple on me (or

nowadays, mandarin oranges ... Mmm) So if the kids or myself get super hungry,

there are no excuses! Saves a lot of cash too!

For us, it's all about planning, organizing, being prepared and NOT putting

yourself in a situation where you know you will binge. If I happen to go grocery

shopping at 5:30pm without a snack in me, I guarantee you I will be leaving the

store with a bag or 2 of Doritos.

I also know, for myself I function sooo much better in the mornings. I have been

known to get up at 4am

Sent from my iPhone

On 2011-11-04, at 7:08 AM, " sarahsimone_soliman "

wrote:

> Hello everyone,

>

> I sure feel like I'm posting a lot lately. I'm renewing my weight loss

efforts, so maybe it's normal that I have more questions right now.

>

> Yesterday I had a bad day. I had an early morning meeting and a long commute,

and failed to leave enough time for a proper breakfast. On top of that I was

feeling extra emotional about some stuff. Long story short, my day consisted of

carbs, carbs, and more carbs (and not the whole grain kind).

>

> Today though, I got right back on track! I woke up, did yoga, made oatmeal. I

just finished a yummy lunch of chicken breast and quinoa with zucchini. I can't

believe how easy it was to self correct! It's really starting to feel like my

healthy habits aren't Herculean efforts anymore, they're just how I live my

life.

>

> I have two questions for you guys.

> 1. The IOWL ep I was listening to today was about rating your hunger. I

haven't tried this yet, but I've been regularly keeping a food journal and I'd

like to incorporate hunger rating. I'd love to hear from you about your

experiences doing this. I suspect it is going to be tricky for me for a while,

not really having a feel for what a 4 is or what a 7 is. Could you share with me

how you guys recognize your hunger levels?

>

> 2. I think one of my biggest downfalls is flexibility. I'm great at schedules,

bad at dealing with curve balls. I'm about to start a part time job, and I'm

nervous about how I'm going to juggle it with my PhD with, while still making

the time to exercise and eat healthfully. Any advice from busy folks? I'd

especially love it if any working moms had advice, as the job I got is a nanny

position.

>

> Thanks so much in advance. This group has been super helpful to me in recent

weeks!

>

> And by the way, for those that gave me advice on snacking, I think things are

going well. I'm trying out 2 afternoon snacks instead of 1. I just had to accept

that I wasn't eating enough.

>

>